We examined participants' reading and recall of informed consent documents presented via paper or computer. Within each presentation medium, we presented the document as a continuous or paginated document to simulate common computer and paper presentation formats. Participants took slightly longer to read paginated and computer informed consent documents and recalled slightly more information from the paginated documents. We concluded that obtaining informed consent online is not substantially different than obtaining it via paper presentation. We also provide suggestions for improving (...) informed consent-in both face-to-face and online experiments. (shrink)

Norman Daniels, in applying Rawls’ theory of justice to the issue of human health, ideally presupposes that society exists in a state of moderate scarcity. However, faced with problems like climate change, many societies find that their state of moderate scarcity is increasingly under threat. The first part of this essay aims to determine the consequences for Daniels’ theory of just health when we incorporate into Rawls’ understanding of justice the idea that the condition of moderate scarcity can (...) fail. Most significantly, I argue for a generation-neutral principle of basic needs that is lexically prior to Rawls’ familiar principles of justice. The second part of this paper aims to demonstrate how my reformulated version of Daniels’ conception of just health can help to justify action on climate change and guide climate policy within liberal-egalitarian societies. (shrink)

Drawing on Christopher Boorse's Biostatistical Theory (BST), Norman Daniels contends that a genuine health need is one which is necessary to restore normal functioning – a supposedly objective notion which he believes can be read from the natural world without reference to potentially controversial normative categories. But despite his claims to the contrary, this conception of health harbors arbitrary evaluative judgments which make room for intractable disagreement as to which conditions should count as genuine health needs and therefore which (...) needs should be met. I begin by offering a brief summary of Boorse's BST, the theory to which Daniels appeals for providing the conception of health as normal functioning upon which his overall distributive scheme rests. Next, I consider what I call practical objections to Daniels's use of Boorse's theory. Finally I recount Elseljin Kingma's theoretical objection to Boorse's BST and discuss its impact on Daniels's overall theory. Though I conclude that Boorse's view, so weakened, will no longer be able to sustain the judgments which Daniels's theory uses it to reach, in the end, I offer Daniels an olive branch by briefly sketching an alternative strategy for reaching suitably objective conclusions regarding the health and/or disease status of various conditions. (shrink)

The central claim is that the semantic knowledge exercised by people when they speak is practical knowledge. The relevant idea of practical knowledge is explicated, applied to the case of speaking, and connected with an idea of agents’ knowledge. Some defence of the claim is provided.

Norman Daniels argues that health is important for justice because it affects the distribution of opportunities. He claims that a just society should guarantee fair opportunities by promoting and restoring the “normal functioning” of its citizens, that is, their health. The scope of citizens' mutual obligations with respect to health is defined by a reasonable agreement that, according to Daniels, should be based on the distinction between normal functioning and pathology drawn by the biomedical sciences. This paper deals (...) with the question whether it is legitimate to ascribe the responsibility of defining this important moral boundary to the biomedical sciences, which Daniels regards as value neutral. Daniels appeals to Christopher Boorse's sophisticated bio-statistical theory (BST) to show the plausibility of a value-neutral distinction between normal functioning and pathology. Here I argue that a careful analysis of the concept of normal functioning, such as the one offered by the recent critique by Elselijn Kingma, shows that it depends from evaluative assumptions. This, I argue, implies that Daniels's theory must give up its naturalistic commitments. In the conclusion, the paper offers a detailed discussion and an objection to one of Daniels's arguments in favor of a moderate form of normativism that remains too close to Boorse's naturalism. (shrink)

Just health: meeting health needs fairly is an ambitious book, in which Norman Daniels attempts to bring together in a single framework all his work on health and justice from the past 25 years. One major aim is to reconcile his earlier work on the special moral importance of healthcare with his later work on the social determinants of health. In his earlier work, Daniels argued that healthcare is of special moral importance because it protects opportunity. In this (...) later work, Daniels argues that the social determinants of health (which in fact tend to have a larger effect on health outcomes than healthcare does) should also be considered special. This paper argues that it is a mistake to base a theory of justice for health on the claim that health (or the social determinants of health) are "special", for three reasons. First, once we realise that health is to a large part socially determined by features such as distribution of income, which are also of independent importance for justice, we cannot talk about a theory of justice for health in isolation from an overall theory of justice. Second, when we are trying to work out the place of health in a general theory of justice, being told that health (or the social determinants of health) is special is unhelpful. The relevant starting point should rather be whether health matters in a fundamental way for justice, or whether it matters merely for the effects it has on those goods which are of fundamental importance for justice. Third, treating the social determinants of health as special would in fact be counterproductive in terms of the broad approach to justice Daniels favours. (shrink)

Darker skin correlates with reduced opportunities and negative health outcomes. Recent discoveries related to the genes associated with skin tone, and the historical use of cosmetics to conform to racist appearance standards, suggest effective skin-lightening products may soon become available. This article examines whether medical interventions of this sort should be permitted, subsidized, or restricted, using Norman Daniels's framework for determining what justice requires in terms of protecting health. I argue that Daniels's expansive view of the requirements of (...) justice in meeting health needs offers some support for recognizing a societal obligation to provide this kind of ‘enhancement,’ in light of the strong connections between skin tone and health outcomes. On balance, however, Daniels's framework offers compelling reasons to reject insurance coverage for skin-lightening medical interventions, including the likely ineffectiveness of such technologies in mitigating racial health disparities, and the danger that covering skin-lightening enhancements would undermine public support for cooperative schemes that protect health. In fact, justice may require limiting access to these technologies because of their potential to exacerbate the negative effects of racism. (shrink)

Could age be a valid criterion for rationing? In Just health, Norman Daniels argues that under certain circumstances age rationing is prudent, and therefore a morally permissible strategy to tackle the problem of resource scarcity. Crucial to his argument is the distinction between two problem-settings of intergenerational equity: equity among age groups and equity among birth cohorts. While fairness between age groups can involve unequal benefit treatment in different life stages, fairness between birth cohorts implies enjoying approximate equality in (...) benefit ratios. Although both questions of fairness are distinct, the resolution of the one depends on resolution of the other. In this paper, I investigate whether Daniels’ account of age rationing could be defended as a fair way of setting limits to healthcare entitlements. I will focus on two main points. First, I will consider whether the age group problem could be resolved without appealing to a conception of the good. Second, I will demonstrate that the connection between the age group problem and the birth cohort problem runs deeper than Daniels initially thought—and that it ultimately suggests a method for prioritisation in problem solving strategies. (shrink)

Norman Daniels’s theory of health justice is the most comprehensive and systematic such theory we have. In one of the few articles published so far on Daniels’s new book, Just Health, Benjamin Sachs argues that Daniels’s core “principle of equality of opportunity does not do the work Daniels needs it to do.” Yet Sachs’s objections to Daniels’s framework are deeply flawed. Where these arguments do not rely on significant misreadings of Daniels, they ignore sensible (...) strands in Just Health that considerably dull their force. After disarming Sachs’s arguments against Daniels’s theory, I explain why I agree with Sachs’s conclusion: Daniels’s equality of opportunity-based account of health justice rests on shaky foundations. (shrink)

Norman Daniels's new book, Just Health, brings together his decades of work on the problem of justice and health. It improves on earlier writings by discussing how we can meet health needs fairly when we cannot meet them all and by attending to the implications of the socioeconomic determinants of health. In this article I return to the core idea around which the entire theory is built: that the principle of equality of opportunity grounds a societal obligation to meet (...) health needs. I point, first, that nowhere does Daniels say just what version of that principle he accepts. I then proceed to construct a principle on his behalf, based on a faithful reading of Just Health. Once we actually nail down the principle, I argue, we will find that there are two problems: it is implausible in itself, and it fails to ground a societal obligation to meet health needs. (shrink)

Just Health, by the well-known American philosopher Norman Daniels, has the ambitious goal of presenting ‘an integrated theory of justice and population health, to address a set of theoretical and real-world challenges to that theory, and to demonstrate that the theory can guide our practice with regard to health both here and abroad.’ (1)1 Daniels's fundamental question is what we owe each other in the way of the protection and promotion of health. He thinks this is fruitfully dealt (...) with by breaking it down and answering three separate questions: (i) what is the moral importance of health? (ii) when are differences in health unjust? and (iii) how should we meet health needs fairly when we cannot meet them all? (11). (shrink)

In various places we have defended the position that a new human organism, that is, an individual member of the human species, comes to be at fertilization, the union of the spermatozoon and the oocyte. This individual organism, during the ordinary course of embryological development, remains the same individual and does not undergo any further substantial change, unless monozygotic twinning, or some form of chimerism occurs. Recently, in this Journal Jason Morris has challenged our position, claiming that recent findings (...) in reproductive and stem cell biology have falsified our view. He objects to our claim that a discernible substantial change occurs at conception, giving rise to the existence of a new individual of the human species. In addition, he objects to our claim that the embryo is an individual, a unified whole that persists through various changes, and thus something other than a mere aggregate of cells. Morris raises a number of objections to these claims. However, we will show that his arguments overlook key data and confuse biological, metaphysical, and ethical questions. As a result, his attempts to rebut our arguments fail. (shrink)

We are delighted to welcome Jason Jewell to our editorial board. Jason Jewell is Professor of Humanities and Chair of the Department of Humanities at Faulkner University in Montgomery, Alabama. He is also an Associated Scholar with the Ludwig von Mises Institute and a faculty member of Tom Woods’s Liberty Classroom, where he is currently preparing ….

Just Health, by the well-known American philosopher Norman Daniels, has the ambitious goal of presenting ‘an integrated theory of justice and population health, to address a set of theoretical and real-world challenges to that theory, and to demonstrate that the theory can guide our practice with regard to health both here and abroad.’ (1)1 Daniels's fundamental question is what we owe each other in the way of the protection and promotion of health. He thinks this is fruitfully dealt (...) with by breaking it down and answering three separate questions: (i) what is the moral importance of health? (ii) when are differences in health unjust? and (iii) how should we meet health needs fairly when we cannot meet them all? (11). (shrink)

In this paper, I discuss the role of care and competence, as well as their relationship to one another, in contemporary medical practice. I distinguish between two types of care. The first type, care1, represents a natural concern that motivates physicians to help or to act on the behalf of patients, i.e. to care about them. However, this care cannot guarantee the correct technical or right ethical action of physicians to meet the bodily and existential needs of patients, i.e. to (...) take care of them—care2. To that end, physicians must be competent in the practice of medicine both as evidence—based science (technical competence) and as patient—centered art (ethical competence). Only then, I argue, can physicians take care of (care2) patients’ bodily and existential needs in a compassionate and comprehensive manner. Importantly, although care1 precedes competence, competence—both technical and ethical—is required for genuine care2, which in turn reinforces an authentic care1. I utilize the play Wit, especially the character Jason Posner, and Francis Peabody’s exposition on caring for patients, to illustrate the role of care and competence in contemporary medical practice. (shrink)

According to Norman Daniels, the moral significance of health needs stem from their impact on the normal opportunity range: pathological conditions involve comparative disadvantage. In this paper I defend an alternative reading of the moral importance of healthcare, which focuses on non-comparative aspects of disease. In the first section I distinguish two contrasting perspectives on pathological conditions, viz a comparative versus a non-comparative. By using this distinction I introduce a related disparity regarding the moral importance of personal responsibility for (...) disease. I claim that people are usually prepared to disregard individual responsibility for disease, if it involves non-comparative harm, but not if it entails mere disadvantage. Since disadvantage means to have less than equal opportunities, Daniels’ conception of opportunity is vital for his theory. It is therefore scrutinised more closely. I try to show that he wavers between two interpretations of the notion of opportunity, which are again linked to the distinction between a comparative and a non-comparative point of view. Finally, I criticise Daniels’ supposition that persons have an interest in the normal opportunity range. (shrink)

Just Health, by the well-known American philosopher Norman Daniels, has the ambitious goal of presenting `an integrated theory of justice and population health, to address a set of theoretical and real-world challenges to that theory, and to demonstrate that the theory can guide our practice with regard to health both here and abroad.’ (1)1 Daniels's fundamental question is what we owe each other in the way of the protection and promotion of health. He thinks this is fruitfully dealt (...) with by breaking it down and answering three separate questions: (i) what is the moral importance of health? (ii) when are differences in health unjust? and (iii) how should we meet health needs fairly when we cannot meet them all? (11). (shrink)

Stanley’s insightful new book refines his earlier formulation of intellectualism. Indeed, it does a whole lot more, but leaves open some tough questions. He makes a powerful case for the view that knowing how to do something is to know, of a certain way, that one could do that thing in that way. But he says surprisingly little about what ways are, and how they might differ, depending on the kind of case. And he doesn't exclude the possibility that in (...) some cases what one knows in knowing-how is a way of doing something rather than a fact about a way of doing it. (shrink)

History of religion, in its beginnings, had to struggle to emancipate itself from classical mythology as well as from theology and philosophy; when ritual was finally found to be the basic fact in religious tradition, the result was a divorce between classicists, treating mythology as a literary device, on the one hand, and specialists in festivals and rituals and their obscure affiliations and origins on the other.

‘Jason…chosen leader because his superior declines the honour, subordinate to his comrades, except once, in every trial of strength, skill, or courage, a great warrior only with the help of magical charms, jealous of honour but incapable of asserting it, passive in the face of crisis, timid and confused before trouble, tearful at insult, easily despondent, gracefully treacherous in his dealings with the love-sick Medea but cowering before her later threats and curses, coldly efficient in the time-serving murder of (...) an unsuspecting child , reluctant even in marriage.’ So Carspecken put the case against Jason's heroism. In the face of such an indictment, Lawall's plea in mitigation, ‘it must be admitted that [Jason] often reveals the qualities of a true gentleman’, seems somehow inadequate. Criticism since Carspecken has found various overlapping categories for Jason which both take account of the earlier negative judgements and preserve the centrality of his ‘personality’ and character in the poem: Jason is the quiet diplomat who works through consensus rather than force, his is a heroism of sex-appeal, he is an anti-hero, the embodiment of Sceptic ‘suspension of judgement’, or, alternatively, he is ‘one of us’, credible and lifelike. Carspecken himself tried a different tack: the poem is concerned not with individual heroism but with the heroism of the group. (shrink)

ABSTRACT Norman Daniels suggests that the just distribution of resources between different age‐groups is determined by the choice a prudential agent would make in budgeting resources over the different temporal stages of a single life. He calls this view the “prudential lifespan account” of justice between age‐groups. Daniels thinks that the view recommends a rough kind of equality in resources between age‐groups. I argue that in the case of a single life prudence would choose an unequal distribution of (...) resources. Consequently, using prudence to model distribution between age‐groups might severely restrict the share of resources assigned to the elderly. If we think that extreme inequality between age‐groups would be unjust, we should continue to think of justice between age‐groups as a problem concerned with the relationship between different lives. But we should apply the requirement of equality to the temporal parts of lives, not just to complete lives. (shrink)